Antimicrobial Stewardship Programs

ANTIMICROBIAL STEWARDSHIP PROGRAMS

Antimicrobial stewardship programs (ASPs) have become a cornerstone in the fight against antimicrobial resistance (AMR), a critical public health issue also recognized globally in the pediatric population. Daniele Donà et al. (2025)

Successful implementation of pediatric ASPs requires a multidisciplinary approach, not only via collaboration between different healthcare workers but also by engaging with patients and their families through education in order to reduce unnecessary antibiotics use and increase compliance

1.What Is an Antibiotic Stewardship Program (ASP)?

An ASP is a comprehensive set of actions designed to promote the responsible use of antibiotics [16,17]. This involves selecting the appropriate drug, dose, timing, frequency, and route of administration based on knowledge of the antimicrobial spectrum and pharmacokinetic/pharmacodynamic data, ideally tailored to the specific clinical condition, limiting the risk of resistance development and the risk of side effects, without compromising the patient outcome. Dellit et al. (2007)

2.Which Healthcare Workers Should Be Involved in an ASP? The Antimicrobial Stewardship Team

Every ASP requires a multidisciplinary team tasked with defining governmental policies for the responsible use of antibiotics, aligning with infection control protocols i) Pediatric infectious disease specialist: the Antimicrobial Stewardship Team (AST) in pediatric care should be led by a pediatric infectious disease specialist or, when absent, by a pediatrician with expertise in antibiotic therapy ii) One expert from each relevant field: a nurse, a clinical pharmacist, a clinical microbiologist, a public health specialist, dietitians, and other physicians, depending on the wards involved in the implementation.

The ASP Team

3.Different Types of ASPs

ASP interventions can be classified as core strategies (i.e., pre-authorization of restricted antimicrobials and prospective audit and feedback), minor interventions, or interventions before and after the prescriptions. D. Donà et al. (2020)

• What Interventions Are Effective Prior to or at the Time of Prescription?

  • Core Strategy

    1. Pre-authorization of restricted antimicrobials

  • Minor Strategies

    1. Local syndrome-specific clinical guidelines and pathways implementation
    2. Healthcare worker education
    3. Computerized clinical decision support (CDS)
    4. Caregivers education
    5. Guidelines for antibiotic allergy and delabeling of spurious antibiotic allergies
    6. Antimicrobial order form

• What Interventions Are Effective After the Time of Prescription?

  • Core Strategy

    1. Prospective audits and feedback (PAF):

  • Minor Strategies

    1. Dose optimization
    2. Appropriate duration and antibiotic timing out
    3. From empiric to target therapy, based on culture results and antibiotic monitoring by pharmacist
    4. Switch to oral

The different Types of ASP

References

Dellit, Timothy H, Robert C Owens, John E McGowan, Dale N Gerding, Robert A Weinstein, John P Burke, W Charles Huskins, et al. 2007. “Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship.” Clinical Infectious Diseases 44 (2): 159–77.

Donà, Daniele, Elisa Barbieri, Giulia Brigadoi, Cecilia Liberati, Samantha Bosis, Elio Castagnola, Claudia Colomba, et al. 2025. “State of the Art of Antimicrobial and Diagnostic Stewardship in Pediatric Setting.” Antibiotics 14 (2): 132.

Donà, D, E Barbieri, M Daverio, R Lundin, C Giaquinto, T Zaoutis, and M Sharland. 2020. “Implementation and Impact of Pediatric Antimicrobial Stewardship Programs: A Systematic Scoping Review.” Antimicrobial Resistance & Infection Control 9 (1): 3.